Photobiomodulation with low-level laser therapy reduces oral mucositis caused by head and neck radio-chemotherapy: prospective randomized controlled trial.

The objective of this study was to assess the effectiveness of photobiomodulation with low-level laser therapy (LLLT) as a preventive and therapeutic procedure for the treatment of oral and oropharyngeal mucositis caused by radio-chemotherapy in patients diagnosed with oral squamous cell carcinoma (SCC). An experimental, prospective, double-blind, randomized controlled study was conducted involving patients diagnosed with oral SCC undergoing oncological treatment. The variables analyzed included grade, appearance, and remission of mucositis. A final sample of 26 patients was included: 11 (42.3%) in the study group and 15 (57.7%) in the control group; their average age was 60.89±9.99years. Statistically significant differences between the groups were observed from week 5 of oncological treatment; 72.7% of the laser group showed normal mucosa (mucositis grade 0), while in the control group, 20.0% showed grade 0 mucositis and 40.0% showed grade 2 mucositis (P<0.01). No statistically significant difference between the groups was found regarding the application or use of medication throughout the study period (P>0.05). The tolerance evaluation did not show any statistically significant difference between the groups regarding the occurrence of side effects or adverse events during the trial (P>0.05). Photobiomodulation with LLLT reduces the incidence and severity of mucositis in patients treated with radiotherapy±chemotherapy.

Nutrición y cáncer / Nutrition and cáncer

La expresión máxima de desnutrición en el cáncer es la caquexia tumoral, que será responsable directa o indirecta de la muerte en un tercio de los pacientes con cáncer. En un Consenso Internacional se ha definido la Caquexia cancerosa como un síndrome multifactorial caracterizado por una pérdida de masa muscular esquelética (con o sin pérdida de masa grasa) que no puede ser completamente revertida con un soporte nutricional convencional y que lleva a un deterioro funcional progresivo. La fisiopatología se caracteriza por un balance proteico y energético negativo, debido a una combinación variable de ingesta reducida y un metabolismo alterado. Se clasifica la Caquexia Tumoral dentro de un continuum evolutivo, con tres estadios de relevancia clínica: Precaquexia, Caquexia, y Caquexia Refractaria; y se asocia con una disminución en la tolerancia al tratamiento oncológico, menor respuesta al mismo, y disminución de la calidad de vida y de la supervivencia del paciente. Para el Cribado nutricional del paciente con cáncer y siguiendo la Guía Clínica Multidisciplinar se recomienda el «Malnutrition Screening Toll» (MST) para los pacientes adultos con cáncer por su sencillez, fiabilidad y validez. Como método de valoración nutricional para enfermos con cáncer, debe mencionarse la Valoración Global Subjetiva (VGS), y sobre todo la VSG Generada por el Paciente. Al describir las causas de desnutrición en el paciente neoplásico las podemos concretar en: a) causas de desnutrición relacionadas con el tumor, b) con el paciente o c) con los tratamientos oncológicos, teniendo en cuenta que en muchas ocasiones todas las causas pueden estar presentes en un mismo paciente. La desnutrición en el paciente con cáncer se asocia, además de un aumento de morbilidad-mortalidad y aumento de estancias y de costes, a una peor evolución y tolerancia de los tratamientos oncológicos (quirúrgicos, radio y quimioterápicos). Los objetivos fundamentales de la intervención nutricional en el paciente oncológico son: Evitar la muerte precoz secundaria a la propia desnutrición; Disminuir las complicaciones y Mejorar la calidad de vida de los pacientes. Para lograr estos objetivos, la intervención nutricional engloba varias opciones que deben individualizarse para cada paciente. En todo caso la atención nutricional debe ser precoz y formar parte del tratamiento global de paciente oncológico. Si se clasifica el apoyo nutricional según su agresividad y complejidad, se incluyen las siguientes categorías: Recomendaciones nutricionales o consejo dietético; Nutrición artificial (Nutrición enteral oral o suplementación, Nutrición enteral por sonda, Nutrición parenteral) y Valoración de la posible adición de fármacos relacionados con la estimulación del apetito, la inhibición de citoquinas, con acción anabolizante, y otros (AU)

The highest expression of malnutrition in cancer is tumour cachexia, which directly or indirectly accounts for the deaths of one third of all the patients with cancer. In a formal international consensus process cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. Tumour cachexia can be classified in three evolutionary stages of clinical relevance: precachexia, cachexia, and refractory cachexia, and it is associated with a decrease in treatment tolerance and responsiveness, and impairment of quality of life and survival in cancer patients. According to the Multidisciplinary Clinical Guide, the Malnutrition Screening Toll (MST) is a simple, reliable and valid instrument which can be useful for nutritional screening of adult patients with cancer. As a method of nutritional assessment for patients with cancer, the Subjective Global Assessment (SGA), and especially the Patient-Generated Subjective Global Assessment (PGSGA) should be also mentioned. The causes of malnutrition in cancer can be related to type of tumour, patient features or cancer treatment, taking into account that in many cases all causes may be present in the same patient. Malnutrition in patients with cancer is also associated to increased morbidity and mortality; longer hospital stays and higher medical care costs, and a worse outcome and tolerance of cancer treatments (surgery, radio- and chemotherapy). Key objectives of nutritional intervention in cancer patients include preventing early death secondary to underlying malnutrition, reducing complications and improving the quality of life of patients with cancer. To achieve these goals, nutritional intervention includes several options that should be individualized for each patient. In any case, nutritional care should be started early and be part of the overall treatment of cancer patients. Based on its aggressiveness and complexity nutritional support can be classified into the following categories: nutrition recommendations or dietary counseling; artificial nutrition (oral supplements, enteral and parenteral nutrition), and evaluation of possible addiction to appetite stimulants, anabolic agents, cytokine inhibitors and other drugs (AU)

Cancer treatment-induced oral mucositis: a critical review.

Head and neck cancer represents one of the main oncological problems. Its treatment, radiotherapy and chemotherapy leads to mucositis, and other side effects. The authors reviewed high-quality evidence published over the last 25 years on the treatment of cancer treatment-induced oral mucositis. A Medline search for double blind randomized controlled clinical trials between 1985 and 2010 was carried out. The keywords were oral mucositis, radiotherapy, chemotherapy, and head and neck. The different therapeutic approaches found for cancer treatment-induced oral mucositis included: intensive oral hygiene care; use of topical antiseptics and antimicrobial agents; use of anti-inflammatory agents; cytokines and growth factors; locally applied non-pharmacological methods; antioxidants; immune modulators; and homoeopathic agents. To date, no intervention has been able to prevent and treat oral mucositis on its own. It is necessary to combine interventions that act on the different phases of mucositis. It is still unclear which strategies reduce oral mucositis, as there is not enough evidence that describes a treatment with a proven efficiency and is superior to the other treatments for this condition.

Quantitative pp65 antigenemia in the diagnosis of cytomegalovirus disease: prospective assessment in a cohort of solid organ transplant recipients.

OBJECTIVES: To assess the accuracy of quantitative pp65 antigenemia (pp65Ag) in the diagnosis of CMV disease, in a cohort of solid-organ transplant recipients. METHODS: Prospective observational study during the first 6 months following transplantation, with determination of pp65Ag at weeks 2, 4, 6, 8, 10, 11, 12, 14 and 16. Sensitivity (S), specificity (E), positive and negative predictive values (PPV, NPV), and the optimal cut-off point for diagnosing CMV disease, were determined. RESULTS: The cohort consisted of 35 liver, 26 renal and 12 heart graft recipients. Thirteen (17.2%) were seronegative and received a seropositive graft. Of 583 blood samples, pp65Ag was positive in 109 (18.7%) from 37 patients (51%). Twenty-two patients developed CMV disease (0.3 episodes/patient); gastrointestinal disease was the most frequent (15 episodes), followed by viral syndrome (3 episodes). Patients with positive pp65Ag had a relative risk for CMV disease of 6.19 [IC95%=1.99-19.04], (P=.0001). Diagnostic values of pp65Ag were: S=86%, E=65%, PPV=51%, NPV=92%. The cut-off of > or =10 infected cells/10(5), at weeks 2, 4, 6 and 8 obtained the best PPV (0, 67, 91 and 54%), and NPV (47, 52, 67 and 50%). CONCLUSIONS: In the studied population, the presence of positive pp65Ag was associated with a high risk of developing CMV disease, and the most useful cut-off point for the diagnosis was > or =10 infected cells/10(5).

Cáncer de mama: papel de la radioterapia / Breast cancer: role of radiotherapy

El cáncer de mama es la primera causa de muerte por cáncer en la mujer y la principal causa de muerte en la mujer entre los 40 y 44 años. En la actualidad se están consiguiendo importantes logros en su curación, debido a destacados avances diagnósticos y terapéuticos, así como a los programas de screenning, que hace que cada vez el diagnóstico se haga en las fases más tempranas de la enfermedad. Su tratamiento requiere una actuación multidisciplinar en la que participan cirujanos, oncólogos radioterápicos y médicos. En este capítulo, los autores realizan una puesta al día del papel de la radioterapia en el tratamiento del cáncer de mama en las diferentes etapas de la enfermedad (AU)